Census survey changes cloud PPACA numbers

People wait to buy health insurance with the help of City of Houston application counselors at a service center in Houston on Monday, March 31. (AP Photo/Michael Stravato)

A change to the Census Bureau survey could affect how they measure the uninsured — and that could impact, and complicate, how the effects of Obamacare are measured.

The new questionnaire — being conducted this month — includes a “total revision” to questions about health insurance, just as analysts are trying to get solid data on how well the Patient Protection and Affordable Care Act is working.

The New York Times reported the change to the annual survey Tuesday, saying the changes are intended to improve the survey’s accuracy. However, officials say the new questions are so different that the findings “will not be comparable,” leaving many worried about not giving an apples-to-apples comparison to pre and post-reform effects in the uninsured population.

Officials said the change could lead to lower attributed numbers of the uninsured.

“We are expecting much lower numbers just because of the questions and how they are asked,” Brett J. O’Hara, chief of the health statistics branch at the Census Bureau, told the Times.

Previously the Census asked people if they had coverage at any point in the prior year, according to the Times. The new questions ask if they have insurance “at the time of the interview,” which in this case took place in February, March and April. Officials use that and other data to try to determine coverage over the last 15 months.

The Times reported that when both questionnaires were used last year, the number of Americans without insurance came in around 2 percent lower under the new questions.

Changes to the Census questionnaire were announced in the Federal Register in September.

The annual Census report measures the number of people with various kinds of health insurance and the number of uninsured for the nation and for each state.

The timing of the changes leaves some questioning the motives behind the change, though it’s being downplayed by officials who say it is merely “coincidental” and “unfortunate.”

“The timing is messy, and there will be significant changes in the data,” said Jenna Stento, senior manager at Avalere Health, noting she’s not surprised about the backlash and “noise” already heard in the both the health industry and in the political arena from the news.

The Census changes will be difficult for “trend analysis” and in analyzing how PPACA is affecting the insured/uninsured population in the next year or two, Stento said. However she said it should “work itself out” in the coming years.

In the meantime, Stento said, “for measuring the reforms, there are alternative data sources that make the Census changes not as earth shattering. The American Community Survey, they already track in this way — it’s a good one with a more robust sample — and there’s data coming directly from the agencies themselves who are starting to give us this data.”

Though the move is causing backlash, Census officials said the changes was years in the making, having nothing to do with PPACA, and it will work better — including making it easier to measure the impact of the health care overhaul in coming years.

“The recent changes to the Current Population Survey’s questions related to health insurance coverage is the culmination of 14 years of research and two national tests in 2010 and 2013 clearly showing the revised questions provide more precise measures of health insurance through improved respondent recall,” Census Bureau Director John Thompson said in a statement.

The Census will now ask respondents questioning referring to PPACA: whether they obtained health coverage on the exchanges and if the federal government subsidized their plans.

Republicans and other opponents seized on the changes, arguing they’re intended to mask the failure of Obamacare.

“If the administration truly wants to know how many people have insurance today because of the health law, it will swiftly reverse course,” House Energy and Commerce Committee Chairman Fred Upton, R-Mich., said in a statement. “Did the health law work to insure the uninsured? A simple check of a box could answer that question. Sadly, we may never know — and the administration seems just fine with that.”

Earlier this month, the White House announced 7.5 million people have enrolled in health care coverage through PPACA, a number that exceeded even the most optimistic enrollment predictions. Millions more have enrolled in expanded Medicaid.

Still the enrollment numbers aren’t completely clear, experts warn. For one thing, some of those who are considered “newly insured” under the law may have been kicked off their insurance plan earlier in the year because of PPACA. Additionally, there have been reports that many of those enrollees have not paid their first month’s premiums and merely chose plans.

The administration also has not released data on the enrollees, including age, health status and demographics information.

Other polls, including ongoing ones from Gallup, have found that the number of uninsured is dropping. Last week, Gallup said the uninsured rate nationally had dropped to its lowest level since 2008 and now stands at 15.6 percent.

Latest numbers from Gallup out Tuesday found that states that expanded Medicaid and set up health exchanges under PPACA are seeing their uninsured rates drop faster than others. On average, the uninsured rate declined 2.5 percentage points in the 21 states, and the District of Columbia, that have implemented both of these measures, compared with a 0.8-point drop across the 29 states that have taken only one or neither of these actions.

“While a majority of Americans continue to disapprove of the Affordable Care Act, the uninsured rate appears to be declining, as the law intended,” Gallup researchers noted.